不同方法切取分叶背阔肌皮瓣在局部晚期乳腺癌术后胸壁缺损修复中的应用价值  

orsi myocutaneous flap in repairing chest wall defect after local advanced breast cancer surgery

作　　者：刘美亚 陈永静[2] 马骏杰 赵振华 罗飞[5] 李炘正[1] Liu Meiya;Chen Yongjing;Ma Junjie;Zhao Zhenhua;Luo Fei;Li Xinzheng(Breast Department II,Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital,Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University Taiyuan 030013,China;Department of Gastroenterology,Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital,Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University,Taiyuan 030013,China;Second Department of General Surgery,Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital,Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University,Taiyuan 030013,China;Imaging Center,Shanxi Bethune Hospital,Taiyuan 030032,China;Breast Department I,Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital,Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University,Taiyuan 030013,China)

机构地区：[1]山西省肿瘤医院、中国医学科学院肿瘤医院山西医院、山西医科大学附属肿瘤医院乳腺二科,太原030013 [2]山西省肿瘤医院、中国医学科学院肿瘤医院山西医院、山西医科大学附属肿瘤医院消化三科,太原030013 [3]山西省肿瘤医院、中国医学科学院肿瘤医院山西医院、山西医科大学附属肿瘤医院普外二科,太原030013 [4]山西省白求恩医院影像中心,太原030032 [5]山西省肿瘤医院、中国医学科学院肿瘤医院山西医院、山西医科大学附属肿瘤医院乳腺一科,太原030013

出　　处：《中华内分泌外科杂志》2023年第5期550-553,共4页Chinese Journal of Endocrine Surgery

摘　　要：目的探讨不同方法切取分叶背阔肌皮瓣在局部晚期乳腺癌(locally advanced breast cancer,LABC)术后胸壁缺损修复中的应用价值。方法选取山西省肿瘤医院2019年2月至2020年1月收治的64例单侧LABC患者的临床资料,均行乳腺癌改良根治术,按照随机数字表法将患者分成2组,将遗留胸壁皮肤软组织缺损采用分别顺行法(A组,32例)及逆行法(B组,32例)设计并切取分叶背阔肌皮瓣移植修复缺损,皮岛切取范围为14 cm×6 cm~19 cm×7 cm;皮瓣供区均直接闭合,比较两组方法的应用效果。结果A组术后1例顺行皮瓣出现部分坏死,B组术后6例逆行皮瓣发生部分坏死,差异无统计学意义(P>0.05);A组供区切口延期愈合率6.25%,明显低于B组25.00%(χ^(2)=4.267,P=0.039)。两组患者术后均随访12~24个月,皮瓣外观、质地均达预期;供区仅遗留有线性瘢痕,肩关节活动度未受影响。平均生存时间20.8个月。结论顺行法切取分叶背阔肌皮瓣可修复LABC术后胸壁大面积缺损,能最大程度确保皮瓣血液运行,保证供区闭合张力最小化,降低术后并发症发生率,促进切口愈合。Objective To explore the application value of different methods of segmented latissimus dorsi myocutaneous flap in repairing chest wall defects after local advanced breast cancer surgery.Methods The clinical data of 64 patients with unilateral locally advanced breast cancer admitted to Shanxi Cancer Hospital from Feb.2019 to Jan.2020 were selected.All patients underwent modified radical mastectomy for breast cancer.The patients were divided into two groups according to the random number table method.Antegrade(group A,n=32 cases)and retrograde(group B,n=32 cases)were used to design and cut the segmented latissimus dorsi myocutaneous flap to repair the defects.The range of skin island cut was 14 cm×6 cm-19 cm×7 cm;The donor area of the flap was closed directly.The application effects of the two groups of methods were compared.Results In group A,one antegrade flap was partially necrotic,while in group B,six retrograde flaps were partially necrotic(P>0.05).The delayed healing rate of donor site incision in group A was 6.25%,significantly lower than that in group B(25.00%)(χ^(2)=4.267,P=0.039).All the patients in both groups were followed up for 12 to 24 months,and the appearance and texture of the flaps were satisfactory;Only linear scar was left in the donor area,and the shoulder joint activity was not affected.The mean survival time was 20.8 months.Conclusion The antegrade latissimus dorsi myocutaneous flap can repair the large area defect of chest wall after LABC,which can ensure the blood supply of the flap to the greatest extent,reduce the closing tension of the donor area,the incidence of postoperative complications,and promote the healing of the incision.

关 键 词：局部晚期 乳腺癌 胸壁缺损 分叶背阔肌 皮瓣修复 

分 类 号：R737.9[医药卫生—肿瘤]